My wife and children for understanding and tolering, the countless hourswhenIwasbehindthecomputerworkingonthisbook.
The invention of computed tomography and magnetic resonance imaging has completelychangedthemorphologicalandfunctionalexplorationofthenervous system and therefore has a very precise approach to diagnosis of the most neurologicaldiseases. The progress in neuroradiological imaging need intensive further training to enableallradiologistsandclinicians,theoptimaluseofthesetechniques. The topics covered in Atlas of Neuroradiology represent the common and important diseases encountered in neuroradiology. The material presented for each case provides a thorough and comprehensive description of the disease entityenablingtheradiologistorthecliniciantodevelopaclearconceptofthe entity through the different imaging modalities that are present. In this book, I attempt,alleasttofillasmallgapofknowledgeinneuroradiologyandhopethat will be useful for residents in radiology, radiologists, neurologists and neurosurgeons.
I would like to acknowledge my teachers, Abdelkrim Berrah Professor and chairman,DepartmentofMedicineatBabEl-ouedUniversityHospital,Algiers, and Professor Moulay Ahmed Meziane, Head Section of Thoracic Imaging, Department of Diagnostic Radiology, Cleveland Clinic Fondation Ohio, USA and Professor Mosleh Al-Raddadi, Head of Radiology Department at King Fahad University Hospital Al Madinah, KSA, for their support and encouragementtocontinuetogrow. I am grateful for the support and friendship of my colleagues Drs Gamal Hassan, Abdullah Al-Taifi, Ridha Okbi, Abdullah Dardiri, Hussain Shahid, Mohammed Bediaf, Djamel Bourenane, Mohammed Said Gouhiri, Djamel Ouslimane, Saadeddine Yassine, Abdelkader Nashed, Abdelwahab M Gabal, Aftab Ahmed Shaikh, Nacer Kernane, Amrane Mohammedi, Mourad Chirou, AbderrahmaneBennouar,FouadAthmani,RabahGourab,yasmineBala,Soraya Benali, Souhil Abida, Farid Abed. Kamel Dahmane, Louardi Mohammedi, ToufikNiaandMahfouthAbdmeziem. I want to thank my family especially my parents, parents in law and my brothersNacer,Abdelkader,AhmedandAbdellatiffortheirloveandsupport. ToMr.AhmedZerguiHeadofCIDISCompany. IwouldliketothankalsoallstaffworkinginourEs-SalemImagingCenter, SamiaHocine,AChinaz,SihamMekaddem,RaniaLombarkia,SamiaGhenai, Nasereddine Benamor, M’hammed Bouguelaa, Ayachi Nezzar, Zoheir Mellah, HichamKadri,MustaphaBenguiba,MustaphaAoura. Finally, I would like to express my gratitude to Mr Oliver Mitchell, Supervisor Publishing Team and Mr. Dennis Taylor Publishing Services AssociatesatTraffordPublishing(Bloomington,USA).
Case1 ClinicalPresentation A 49 year-old female patient with new onset of nausea, vomiting, mild left weakness,rightfacialnumbness,vertigo,andataxia.
MRScanofbrainaxialFLAIR(A),andT2(B)andsagittalT2(C)of spineshowafocalhighsignalintensityareaoftheleftmedulla.Noother abnormality of the cerebellar hemispheres or the spinal cord. This is consistentwithanacuteinfarctinthePICAdistribution.
Nonenhanced brain CT Scan: The first brain CT Scan(A, B) done few hoursaftertheacuteonsetshowsnormalsizeanddensityofthebrainstem andbothcerebellarhemispheres.ThesecondCTScan(C,D)done48hours later shows an enlarged brainstem with large central low-density area
BrainMR,non-enhancedsagittalT1(A),axialFLAIR(B),coronalT2 (C) and MRA-3D-TOF (D) showing a low-T1 and high-FLAIR and T2 lesioninvolvingtherightanterolateralaspectofthepons.TheMRAshows completethrombosisoftherightvertebralartery.
PlainbrainCTScanrevealsalargelow-densityareaintherighttemporooccipital region in the distribution of the posterior cerebral artery (PCA) territory with mass effect on the adjacent temporal horn. No other abnormality.
PlainbrainCTScanshowinglargelow-attenuationareasinvolving both gray and white matter of the cerebellar hemispheres and occipital regions withobliterationofthecerebellarandoccipitalsulciandmasseffectonthe 4thventricle.Notecalcificationoftherightvertebralartery(imageA).
Nonenhanced brain CT Scan (A, B) demonstrates a large low-density area within the distribution of the superficial territory of the left middle cerebralartery(MCA)withlossofthegray-whitematterdifferentiationand adjacent sulcal effacement. No significant ventricular compression or midlineshift.
Case7 ClinicalPresentation A 57 year-old male patient fell while sking 2 days ago and developed acute visualdeteriorationwithlefthemiplegia.
Plain CT Scan reveals a large low-attenuation area involving the right middle cerebral artery (MCA) territory with dense MCA, containing hyperdenseareas(hemorrhagictransformation)withsulcaleffacementand mildmasseffectontheadjacentlateralventricle.
Case8 ClinicalPresentation A 47 male patient with no particular past-history, presenting a sudden left hemiplegia.
ThefirstCT(A)showsahyperattenuatedlinearvascularstructureinthe right temporal region (hyperdense MCA sign), representing thrombus formation within the vessel (early CT sign of ischemia). The second CT (B, C, D) done three days later shows a large low density area in the distribution of the MCA territory, containing hyperdense areas
…continued, MR Scan (done four days later) sagittal T1 (D), axial FLAIR (E), coronal T2 (F) and MRA 3D-TOF (I) images show the extensionoftheinfarctintherightMCAterritoryasalargeareaoflow-T1 and high-T2 and FLAIR signal intensity, containing area of hemorrhage drawing the lentiform nucleus. The MRA shows complete thrombosis of the right internal carotid artery (ICA) and partial of M1 segment of MCA,whichissuppliedbytherightanteriorandposteriorcommunicating arteries.